1/8. abdominal pain in children.Chronic vague abdominal pain is an extremely common complaint in children over 5 years, with a peak incidence in the 8 to 10 year group. In over 90 per cent of the cases no serious underlying organic disease will be discovered. Most disease states can be ruled out by a careful history, a meticulous physical examination, and a few simple laboratory tests such as urinalysis, sedimentation rate, hemoglobin, white blood count determination, and examination of a blood smear. If organic disease is present there are often clues in the history and the examination. The kidney is often the culprit--an intravenous pyelogram should be done if disease is suspected. barium enema is the next most valuable test. Duodenal ulcers and abdominal epilepsy are rare and are over-diagnosed. If no organic cause is found, the parents must be convinced that the pain is real, and that "functional" does not mean "imaginary." This is best explained by comparing with "headache"--the headache resulting from stress and tension hurts every bit as much as the headache caused by a brain tumor or other intracranial pathology. Having convinced the patient and his parents that no serious disease exists, no further investigation should be carried out unless new signs or symptoms appear. The child must be returned to full activity immediately.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/8. Video-EEG and ictal SPECT in three patients with both epileptic and non-epileptic seizures.We report scalp EEG and ictal SPECT findings in epileptic (complex partial) and non-epileptic seizures in three patients who experienced both types of event during presurgical investigation of medically intractable epilepsies. In all three patients, ictal SPECT showed localizing changes in cerebral blood flow during epileptic seizures, but showed no change during pseudoseizures. In two patients, the physical manifestations of the pseudoseizures were similar to those of the epileptic seizures, supporting the contention that physiological activation is unlikely to mimic ictal perfusion changes. In one patient, the EEG recording was rendered difficult to interpret by muscle artefact, while SPECT was clear and showed no change. SPECT is not a primary tool for diagnosis of pseudoseizures, but when patients undergoing presurgical investigation are injected during pseudoseizures, then SPECT is unlikely to show misleading perfusion changes due to activation effects, and may aid diagnosis where there is muscle artefact on EEG.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/8. Localising and lateralising value of ictal piloerection.BACKGROUND: piloerection is a rare clinical symptom described during seizures. Previous reports suggested that the temporal lobe is the ictal onset zone in many of these cases. One case series concluded that there is a predominant left hemispheric representation of ictal cold. The aim of this study is to evaluate the localising and lateralising value of pilomotor seizures. methods: medical records of patients who underwent video electroencephalogram (EEG) monitoring at the Cleveland Clinic between 1994 and 2001 were reviewed for the presence of ictal piloerection. The clinical history, physical and neurological examination, video EEG data, neuroimaging data, cortical stimulation results, and postoperative follow ups were reviewed and used to define the epileptogenic zone. Additionally, all previously reported cases of ictal piloerection were reviewed. RESULTS: Fourteen patients with ictal piloerection were identified (0.4%). Twelve out of 14 patients had temporal lobe epilepsy. In seven patients (50%), the ictal onset was located in the left hemisphere. Four out of five patients with unilateral ictal piloerection had ipsilateral temporal lobe epilepsy as compared with the ipsilateral side of pilomotor response. Three patients became seizure free after left temporal lobectomy for at least 12 months of follow up. An ipsilateral left leg pilomotor response with simultaneously recorded after-discharges was elicited in one patient during direct cortical stimulation of the left parahippocampal gyrus. CONCLUSIONS: Ictal piloerection is a rare ictal manifestation that occurs predominantly in patients with temporal lobe epilepsy. Unilateral piloerection is most frequently associated with ipsilateral focal epilepsy. No hemispheric predominance was found in patients with bilateral ictal piloerection.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/8. Bizarre behavior during intracarotid sodium amytal testing (Wada test): are they predictable?The intracarotid sodium amytal test (ISAT or Wada Test) is a commonly performed procedure in the evaluation of patients with clinically refractory epilepsy candidates to epilepsy surgery. Its goal is to promote selective and temporary interruption of hemispheric functioning, seeking to define language lateralization and risk for memory compromise following surgery. Behavioral modification is expected during the procedure. Even though it may last several minutes, in most cases it is subtle and easily manageable. We report a series of patients in whom those reactions were unusually bizarre, including agitation and aggression. Apart of the obvious technical difficulties (patients required physical restraining) those behaviors potentially promote testing delay or abortion and more importantly, inaccurate data. We reviewed those cases, seeking for features that might have predicted their occurrence. overall, reactions are rare, seen in less than 5% of the ISAT procedures. The barbiturate effect, patients' psychiatric profiles, hemisphere dominance or selectiveness of the injection were not validated as predictors. Thorough explanation, repetition and simulation may be of help in lessening the risk of those reactions.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/8. Pure amnestic seizures in temporal lobe epilepsy. Definition, clinical symptomatology and functional anatomical considerations.Pure amnestic seizures (PAS) sometimes occur in patients with temporal lobe epilepsy. They never represent the only type of seizures in these patients. Pure amnestic seizures are defined as seizures during which the only clinical manifestation is the patients' inability to retain in memory what occurs during the seizure coupled with the preservation of other cognitive functions and the ability to interact normally with their physical and social environment. It is postulated that PAS result from selective ictal inactivation of mesial temporal (MT) structures without isocortical involvement. This occurs most often in patients with neuropsychological and electroencephalographic (EEG) evidence of bilateral dysfunction of MT structures (six out of eight patients in this study). In the few patients without such evidence as well as in some with bilateral MT dysfunction, PAS may result from seizure discharge limited to the MT structures of both temporal lobes. In the light of current anatomical knowledge, contralateral spread of seizure discharge from the MT structures of one side to those of the other through the dorsal hippocampal commissure is the only likely explanation for this situation. One observation with depth electrode stimulation of MT structures supports this view. In patients with evidence for bilateral MT dysfunction, a unilateral seizure may presumably suffice to induce a PAS, the contralateral MT structures being unable to ensure normal memory function. In most instances PAS can be distinguished from episodes of transient global amnesia on clinical grounds.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/8. Dual mental functioning in a split-brain patient.Case studies of two individuals who had undergone complete corpus callosotomies are presented. In addition to anecdotal observations, controlled neurobehavioral and neuropsychological testing indicated that although both parents demonstrated the disconnection syndromes unique to "split-brain" patients, they also differed rather dramatically. For example, 1-C's left hemisphere developed bilateral motor control, whereas 2-C demonstrated the presence of two independent forms of conscious-awareness, one of which resided in the right and the other in the left hemisphere. Hence, 2-C's right brain was capable of gathering, understanding, recalling, and expressing (nonverbally) various forms of information as well as directing independent behavioral activity as manifested by his left extremities. Indeed, 2-C's left arm and leg not only engaged in controlled, directed, and purposeful behavior, but at times performed activities that his left hemisphere found objectionable and annoying. In some instances, physical struggles that involved the right and left extremities of this patient were observed. In contrast, 1-C's right hemisphere appeared to be lacking in higher-level cognitive capabilities. Speculations with regard to mental activity and hemispheric laterality are presented.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/8. Self-abatement of complex partial seizures.Seven of 71 patients with complex partial seizures claimed they were able to abate their seizures, while none of 18 with simple partial seizures were able to do so. Self-abatement exercises included highly stereotyped cognitive and physical components unique to the individual. Those who could abate their seizures had attained higher educational status, better social and vocational adjustment, and better psychological adjustment than did the control group of patients with epilepsy. The self-abatement group was also more likely to have right hemispheric electroencephalographic abnormalities. Characterization of the self-abatement group may be relevant to the selection of candidates for behavioral therapy for epilepsy.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/8. Violent automatism in a partial complex seizure. Report of a case.We describe a patient who had a violent automatism that occurred during a partial complex seizure. The initial spike wave activity was recorded from nasopharyngeal leads that were lost as the patient began his vigorous, violent activity. This activity included nondirected, automatic, stereotyped behavior with physical assaults on objects in his path.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |